title: Plastic and metal stents for postoperative benign bile duct strictures: the best and the worst.
abstract: BACKGROUND
  Endoscopic treatment of postoperative benign bile duct strictures (BBDS) is technically challenging, and the long-term outcome after stricture dilation remains poorly defined.
  
  
  METHODS
  Forty-eight cases of postoperative BBDS with attempted endoscopic treatment (either transient plastic stenting or definitive metal stent insertion) were reviewed.
  
  
  RESULTS
  Endoscopic stricture dilation succeeded in 47 of 48 cases (98%). No procedure-related mortality was observed; 16 (33%) procedure-related or stent-associated complications were observed during treatment. Endoscopic treatment was interrupted in five patients. Stricture relapse occurred in 6 of 6 (100%) and 7 of 36 (19%) patients after metal stent insertion and plastic stent removal, respectively (p < 0.001) (mean follow-up periods 50+/-12 and 44+/-34 months, respectively). After plastic stent removal, stricture relapses were more frequent among patients with strictures related to liver transplantation as opposed to other surgical procedures (p < 0.05); these recurrent strictures were successfully treated by repeated insertion of plastic stents on a temporary basis. At the end of follow-up, all but one patient treated with plastic stents had normal serum alkaline phosphatase values.
  
  
  CONCLUSIONS
  Metal stents proved to be inadequate for treating postoperative BBDS. Temporary insertion of a plastic stent (possibly repeated) provided long-term results equal or superior to those reported for surgical biliary drainage. Repeated insertion of plastic stents was more frequently indicated for strictures related to liver transplantation compared with other surgical procedures.
authors.affiliation: Department of Gastroenterology and Hepatopancreatology, Erasme University Hospital, Brussels, Belgium.
authors.forename: J M
authors.initials: JM
authors.lastname: Dumonceau
authors.forename: J
authors.initials: J
authors.lastname: Devière
authors.forename: M
authors.initials: M
authors.lastname: Delhaye
authors.forename: M
authors.initials: M
authors.lastname: Baize
authors.forename: M
authors.initials: M
authors.lastname: Cremer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001649:Bile Duct Diseases / Q000473:pathology / Q000601:surgery*; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery; D016009:Chi-Square Distribution; D002758:Cholangiography; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D004106:Dilatation / Q000295:instrumentation; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010969:Plastics; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals; D010969:Plastics